title: Stent thrombosis with second- versus first-generation drug-eluting stents in real-world percutaneous coronary intervention: analysis of 3806 consecutive procedures from a large-volume single-center prospective registry.
abstract: OBJECTIVE
  When compared to their first-generation (1stGEN) counterparts, second-generation (2ndGEN) drug-eluting stents (DESs) have been associated with better clinical outcomes in randomized clinical trials, namely by reducing the rates of stent thrombosis (ST). Our goal was to investigate whether or not the broad use of newer devices would translate into higher safety in a real-world population. For that purpose, we compared the occurrence of definite ST at 12 months between two patient subsets from a large-volume single-center registry, according to the type of DES used. Total mortality was a secondary endpoint.
  
  
  RESULTS
  Between January 2003 and December 2010, a total of 3806 patients were submitted to percutaneous coronary intervention (PCI) with only 1stGEN or 2ndGEN DES: 2388 patients (62.7%) were treated with 1stGEN DES only (sirolimus-eluting stent [SES] = 1295 [34.0%]; paclitaxel-eluting stent [PES] = 943 [24.8%]; both stent types were used in 150 patients) and 1418 patients (37.3%) were treated with 2ndGEN DESs only. The total incidence of definite ST (as defined by the Academic Research Consortium) at 12 months was 1.2% (n = 46). After correction for baseline differences between study groups and other variables deemed to influence the occurrence of ST, the use of 1stGEN DES was associated with a significant 2.4-fold increase in the risk of definite ST (95% confidence interval [CI], 1.05-5.42; P=.039) at 12 months; adjusted risk was higher with PES (hazard ratio [HR], 3.6; 95% CI, 1.48-8.70; P=.005) than with SES (HR, 2.3; 95% CI, 0.92-5.65; P=.074). Total mortality (3.7% vs 3.5%) did not differ significantly between groups (adjusted HR, 1.2; 95% CI, 0.81-1.84, P=.348).
  
  
  CONCLUSIONS
  Our data suggest that in the real-world setting of contemporary PCI, the unrestricted use of newer 2ndGEN DESs translates into an improvement in PCI safety (relative to 1stGEN DESs), with a significantly lower risk of definite ST at 12 months.
authors.affiliation: Cardiology Department - Santa Cruz Hospital, Centro Hospitalar Lisboa Ocidental, Av Professor Reinaldo dos Santos, 2799-523 Carnaxide, Lisbon, Portugal. heldores@hotmail.com
authors.forename: Helder
authors.initials: H
authors.lastname: Dores
authors.forename: Luís
authors.initials: L
authors.lastname: Raposo
authors.forename: Rui
authors.initials: R
authors.lastname: Campante Teles
authors.forename: Carina
authors.initials: C
authors.lastname: Machado
authors.forename: Sílvio
authors.initials: S
authors.lastname: Leal
authors.forename: Pedro
authors.initials: P
authors.lastname: Araújo Gonçalves
authors.forename: Henrique
authors.initials: H
authors.lastname: Mesquita Gabriel
authors.forename: Manuel
authors.initials: M
authors.lastname: Sousa Almeida
authors.forename: Miguel
authors.initials: M
authors.lastname: Mendes
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000628:therapy*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects* / Q000145:classification*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel; D020123:Sirolimus